Plastic and reconstructive surgery
-
Plast. Reconstr. Surg. · Oct 2014
Nonendoscopic deactivation of nerve triggers in migraine headache patients: surgical technique and outcomes.
Low efficacy, significant side effects, and refractory patients often limit the medical treatment of migraine headache. However, new surgical options have emerged. Dr. Bahman Guyuron and others report response rates between 68 and 95 percent after surgical deactivation of migraine trigger sites in select patients. In an effort to replicate and expand migraine trigger-site deactivation surgery as a treatment option, the authors' group and others have developed nonendoscopic algorithms. The exclusion of endoscopic techniques may be useful for surgeons with little experience or limited access to the endoscope and in patients with challenging anatomy. ⋯ Therapeutic, IV.
-
Plast. Reconstr. Surg. · Oct 2014
Case ReportsThe volar forearm fasciocutaneous extension: a strategy to maximize vascular outflow in post-burn injury hand transplantation.
Patients with circumferential extremity burns may have a deficiency of cutaneous veins, which presents a challenge for both autologous reconstruction and vascularized composite allotransplantation. The authors present a 44-year-old, left-hand-dominant man with metacarpal level amputation of his left hand secondary to burn injury. ⋯ The patient underwent unilateral left hand transplantation with an allograft designed to include a volar forearm fasciocutaneous extension supplied by the radial artery and including the basilic vein to permit augmented venous drainage by means of anastomosis at the antecubital fossa. The volar forearm fasciocutaneous extension can increase vessel caliber and possibly improve reliability in the setting of hand transplantation and should be considered following severe burn injury.
-
Plast. Reconstr. Surg. · Oct 2014
Putting it all together: recommendations for improving pain management in plastic surgical procedures-surgical facial rejuvenation.
Postoperative pain is a major concern for patients undergoing facial aesthetic surgery. Aggressive efforts to reduce postoperative pain while avoiding adverse sequelae, such as nausea and vomiting, will result in an improved patient experience. Newer pharmaceuticals, medical devices, and longer-acting local anesthetics offer the potential to reduce pain and enhance patient satisfaction. The purpose of this report is to review the options and apply them to 3 specific facial aesthetic procedures: face-lift, brow lift, and blepharoplasty. ⋯ Recent advances in postoperative pain control can significantly improve the patient's surgical experience. This multimodal therapy includes new pharmaceuticals, longer-acting local anesthetics, and devices designed to minimize postoperative pain. Adoption of these techniques may also reduce the need for narcotics and prevent postoperative adverse sequelae.